Hearing Care | Managed Care Health Plans

A majority of benefit packages do not contain this coverage. The aging population, coupled with a noisy contemporary society, contribute to hearing loss/impairment, and it is estimated that more than 10 percent of the population is affected. Despite the generally acknowledged increase in the number of hearing-impaired persons and the substantially improved technology of hearing-aid instruments available, many would rather continue with this impairment than bear the stigma of wearing a hearing aid in public.

Coverage

Surgical procedures affecting the ear are normally covered in standard medical policies. Beyond this, some HMOs, major medical, and comprehensive policies include hearing aids. However, more complete coverage is afforded by plans designed specifically to cover hearing care.

Hearing Care Benefits

A common benefit package includes an 80 percent reimbursement of services and materials up to a ceiling of $300 to $600. The frequency of benefit availability is usually every 36 months. The following items are often covered:

• Otologic examination (by a physician or surgeon).
• Audiometric examination (by an audiologist).
• Hearing instrument (including evaluation, ear mold fitting, and follow-up visits).

Preferred provider plans in which access to a panel would result in discounts for audiologist fees as well as hearing-aid instruments are also available. Several administrators have developed service plans in which copayments apply when participating providers are utilized. Material costs can be reimbursed on a cost-plus dispensing-fee basis. However, identical procedures vary in different geographic areas and even within specific metropolitan areas.

As with vision care expenses, an FSA is a convenient vehicle through which to budget for hearing care expenses in the absence of employee benefit coverage.